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The presumptive diagnosis of constitutional delayed adolescence is difficult to substantiate. Clinical examination and routine biochemical testing are not sufficient to exclude isolated gonadotrophin deficiency. Seven males are reported who presented with delayed puberty. These patients were given 100 μg luteinizing hormone-releasing hormone (LH-RH) intravenously, and the luteinizing hormone (LH) and follicle stimulating hormone (FSH) responses were measured. Three of four males who were completely prepubertal (Stage 1) had a normal adult male response. These three patients have progressed further into puberty several months after this diagnostic test. The fourth patient in stage 1 puberty had a prepubertal LH response. A year later the response became adult in type, and 3 months thereafter stage 2 puberty was evident. The LH response to LH-RH thus appears to have some prognostic value in the assessment of males presenting with delayed puberty. [ABSTRACT FROM PUBLISHER]

The case records of 262 patients who received 131I therapy during a 6-year period were analysed retrospectively. These included seventy-eight patients who received more than one therapeutic dose. The major indication for 131I therapy was thyrotoxicosis occurring in patients aged 40 years and over. The racial incidence in this series is striking. The effects on thyroid function of two low-dose schedules (4 mCi and 6 mCi) were compared. The major complication encountered was hypothyroidism. 4 mCi appears to be as effective as 6 mCi with the added advantage of producing less hypothyroidism. [ABSTRACT FROM AUTHOR]

Gustatory sweating is a potential manifestation of autonomic dysfunction in diabetes. This syndrome is seen in long-standing diabetes and is associated with nephropathy, peripheral neuropathy, and other signs of dysautonomia. Symptoms of profuse head and neck diaphoresis with eating may suggest this clinical diagnosis. We present a patient who had complicated diabetes with symptoms of gustatory sweating and other evidence of dysautonomia. Diagnosis and treatment possibilities are discussed, with a review of the literature and an emphasis on bedside testing.

The preferred treatment for patients with multifocal thyroid carcinoma or a single focus of malignancy larger than 1.5 cm is near-total thyroidectomy followed by radioiodine ablation therapy of the remaining thyroid tissue. The authors describe a patient who had a 2.6-cm papillary thyroid carcinoma but no evidence of metastatic disease. This malignancy was not diagnosed during intraoperative frozen section examination, but rather at the final pathologic analysis. The unilateral thyroid lobectomy resulted in a recurrent laryngeal nerve palsy. During subsequent I-131 therapy of the remaining lobe, features of acute radiation thyroiditis, including thyrotoxicosis, developed.

This study was performed to evaluate whether the presence of either nasal or oral gastric tubes (GTs) would affect the ability to accomplish transesophageal atrial pacing (TAP). After endotracheal intubation, pacing esophageal stethoscopes were placed and the TAP thresholds were measured in 20 patients. With the PES fixed in position, GTs were inserted and pacing thresholds were remeasured. TAP was accomplished in all patients pre- and postinsertion. The mean +/- SD, range, and median TAP thresholds (mA) were 13.7 +/- 5.8, 7-25, and 12 preinsertion and 13.9 +/- 5.2, 5.5-25, and 13 postinsertion. The preinsertion-postinsertion differences ranged from -6 to 5 mA with a mean of the difference of -0.2 mA (95% confidence interval, -1.61-1.21 mA). No significant difference between the pre- and postinsertion groups was detected by the paired t-test, P = 0.77. In summary, the presence of GTs does not significantly affect TAP thresholds. Attempts to achieve TAP are expected to be successful in patients with either a nasal or oral GT in place.

A patient with clinical and biochemical evidence of Cushing's disease and severe hyperlipidemia underwent an adrenal imaging procedure with NP-59 (6 beta-[131I]iodomethyl-19-norcholesterol), without visualization of either gland. Correction of the hyperlipidemia followed by repeated adrenal imaging resulted in bilateral visualization. A pituitary tumor was removed at surgery, confirming the diagnosis of Cushing's disease.

Platelets from diabetic patients show both increased platelet adhesiveness and sensitivity to aggregating agents. Plasma levels of the platelet-active von Willebrand Factor and the closely related factor-VIII antigen are significantly elevated, while factor VIII procoagulant activity is not. This may reflect either intravascular coagulation or disproportionate production or degradation. Plasma factors that enhance ADP-induced platelet aggregation are found in 50% of unselected male diabetics. Activity is clearly demonstrated only when plasma is added immediately prior to adding subthreshold doses of ADP to platelet-rich plasma obtained from control subjects. Systematic investigations of the molecular nature of such factors and their interactions with platelets are in progress. In platelets obtained from diabetic subjects, we have previously found increased sensitivity to the aggregating effects of arachidonic acid, and increased synthesis of immunoreactive prostaglandin E-like material. More recent studies have shown that platelets obtained from diabetic subjects are less sensitive to the antiaggregatory effects of imidazole, a thromboxane synthetase inhibitor. These observations suggest that increased synthesis of the labile aggregating substance thromboxane A2 also occurs in platelets obtained from diabetics. Collectively, these platelet and plasma abnormalities may contribute to accelerated vascular disease of diabetes. Prospective studies using antiplatelet agents are presently underway or in the planning stages in diabetics to explore their potential beneficial effects.

A study was performed to evaluate changes in serum prolactin levels after simple and complex partial seizures, and to identify which specific anatomical structures must be involved in seizures for postictal elevation of prolactin levels to occur. Seventy-eight seizures were studied in patients with electrodes implanted bilaterally into amygdala, hippocampus, hippocampal gyrus, and frontal sites. All 38 complex partial seizures had bilateral limbic ictal discharges, and each was followed by a significant increase in prolactin concentration (mean peak, 50.8 ng/ml; range, 16.0 to 150.0 ng/ml). Eight of 10 simple partial seizures with unilateral high-frequency regional limbic discharges were followed by prolactin elevation (mean peak, 28.2 ng/ml; range, 13.4 to 44 ng/ml). Thirty simple partial seizures with other ictal limbic discharges or without limbic discharges were not followed by an elevated prolactin level. The data indicate that serum prolactin levels always rise after complex partial seizures involving the temporal lobes, and rise after certain simple partial seizures involving limbic structures. Thus, measurement of the prolactin level can help identify which simple partial seizures involve mesial temporal lobe structures. Limbic structures serve to trigger prolactin release, which may depend upon spread of the seizure to subcortical structures.